Monday, September 26, 2011

A Milk Sharing How-To

Read to the bottom for more information about milk sharing and how you can celebrate this important week, including a Blog Hop style linky for all your World Milk Sharing Week posts!

We all know that human breastmilk is the best nutrition for human babies, and it has loads of health benefits for both mom and baby. In some cases however, breastfeeding doesn't work out, it takes longer than usual to establish, induced lactation is unsuccessful, or circumstances arise that necessitate early or temporary weaning. In all of these situations, a substitute for mom's milk would be necessary. According to a joint statement from the WHO and UNICEF, "The best food for a baby who cannot be breastfed is milk expressed from the mother's breast or from another healthy mother. The best food for any baby whose own mother's milk is not available is the breastmilk of another healthy mother."

The price of purchasing human milk from a milk bank is prohibitive for most families. However, with the increasing popularity of sites such as Human Milk 4 Human Babies, Eats on Feets, and Milk Share, direct (mom-to-mom) milk donation is getting easier. And what a good thing!

I pumped daily and donated milk to several people for the first eight months after my son was born. I started pumping as a way to cope with a large supply of milk that came with a very strong letdown reflex (which often caused my baby to cough and choke on milk). I tried to down-regulate my supply (by only pumping to comfort to relieve the pressure of engorgement) but my supply was abundant, and I was happy to help out by donating milk.

Through my son's pediatrician, I got in contact with my first recipient mother, an adoptive parent who, after having little success trying to induce lactation for her first child, was seeking donations for her second exclusively breastfed baby. Later, when a close friend of mine had her baby and her milk didn't come in, I was happy to give my extra milk to her and her son. There have been a few other instances where I've given one-time donations when friends (or friends of friends) have had emergency situations where they were unable to breastfeed for short periods of time (having surgery, needing to take incompatible medications, etc.). While I don't pump daily anymore, I am still "on-call" for several people in case of supply shortages and any other emergencies.

Along with the increasing availability and awareness about providing expressed milk for babies in need, comes a whole host of potentially difficult situations in the donor/recipient relationship. As a donor, I have encountered a few situations where it would've been helpful to have someone to ask about what the etiquette should be, or just to talk to about when it was getting difficult. Here are a few tips (based on my experience so far) for navigating the sometimes tricky and often wonderfully rewarding waters of direct milk donation:

Be upfront with your recipient family about whether this will be a one-time donation or an ongoing donation. If you're not sure if you can get into to an ongoing donation situation, be honest with the recipient about that from the beginning. They have most likely interacted with several donors, and they'll understand the commitment it takes to be an ongoing donor.

Expect to be asked questions about your health history, vitamin and supplement usage, and lifestyle and dietary habits (including use of tobacco, caffeine, and alcohol).

Try not to take it personally! The recipient family is just doing the best they can to provide the best nutrition for their baby.

Be sure to mention to the recipient family if you are on a special diet, as some babies have allergies or intolerances that may need to be taken into consideration. (For instance, if you are a vegan, or don't eat dairy or follow a gluten-free diet, your milk may be a better match for a vegan family, or a baby who has a dairy or gluten intolerance.)

This is entirely based on the recipient's comfort level, so on one end of the spectrum, you may be asked only a few questions, and on the other end, you may be asked to fill out health history paperwork and even provide copies of blood work (HIV results, etc.) to prove that you're healthy enough to donate milk.

If you're going to donate on an ongoing basis, agree on the logistics of the milk exchange:

Will the recipient pick it up directly from the donor's house at regular intervals? How often will that happen?

Will the donor contact the recipient when she has milk to offer or will the recipient contact the donor when there is a need?

Will the recipient provide milk storage bags for the donor?

If you live close enough to each other, does the recipient prefer to pick up smaller quantities of fresh milk on a more regular basis as opposed to larger amounts of frozen milk?

Does the recipient have a preference for how many ounces are stored in each bag (for instance, if your recipient family is feeding exclusively donor milk, they may be open to larger quantities in each bag, while the family who is supplementing with donor milk may want smaller amounts to work with in each bag.) As an aside: may favorite freezer bags are the Lansinoh brand, and despite the markings on the bag, they can hold up to 12 ounces of milk, which is pretty great if you're trying to conserve bags!

It's important to regularly check in with yourself on an emotional level, so you're aware of how you're feeling about donating your milk.

Regularly reevaluate why you're doing this: is it because you want to, or because you feel obligated? Is it bringing you joy or causing you extra stress?

If you begin to feel overwhelmed, burdened, or pressured, it may be time to let an ongoing recipient know that you can't keep up with their need.

If you find that the prospect of being an ongoing donor is overwhelming or puts undue pressure on you (or you've tried it in the past, and it didn't work well for you), consider making multiple one-time donations to different families instead. That way, you can donate exactly as much as you want, and as often or infrequently as you like, without feeling beholden to anyone.

I think as mothers, we often have a desire to be able to take care of everyone, but if you're not taking care of yourself first, then you can't fully give of yourself (and your milk!) to others.

Similarly, it's very important to regularly check in with yourself physically:

Making milk is exhausting when you're doing it for your own baby. Making extra milk for another baby, and spending time pumping, freezing, shipping, etc., can definitely take its toll on your body and your energy level.

Changes in milk supply happen daily, and circumstances in your life may decrease your milk supply. I remember a few times when my son or I would get sick, or he would go through a growth spurt, and all of a sudden I wasn't able to pump as much as I could the day before. I began to worry that I wouldn't be able to provide enough milk to the baby I was pumping for. In those instances, it was extremely important for me to follow my final point:

Keep an open line of communication with your recipient family. Let them know if/when:

Your supply drops;

you or your nursling is sick;

you're going out of town (and will/will not be shipping or bringing back milk);

you're feeling overwhelmed or overly burdened;

or when it's time for you to stop donating.

I was lucky enough to be good friends with the recipient of most of my donated milk, so I think that made it easier for me to talk to her about dips in supply and illness. Ultimately, I began to find it impractical to continue my daily pumping routine, and I let my friend know when that happened. At the same time, she told me that her milk supply had nearly caught up with her son's needs, and they were supplementing with my milk less and less already. It was a natural transition for all of us (a weaning, of sorts), and I found that when I stopped pumping, my body was finally ready to stop making so much extra milk.

While it can sometimes be tricky, sharing breastmilk is a huge and wonderful gift you can give. Breastmilk is often referred to as "liquid gold" and it is certainly an invaluable resource to a family who needs it. I've found it to be a truly rewarding experience—in a way that I can't quite describe accurately in words—to give of myself in this way to another mom and baby. I hope you'll consider donating your milk if you have any to spare!

To me, World Milksharing Week celebrates community, really, an ancient community that is alive and thriving today. Milksharing has been around for as long as women have been having babies in the form of one mother wet nursing the child of another mother in need of milk. Today the more common forms of milksharing happen with expressed milk from the breast of one woman offered generously to the child of another mother in need of milk.

I totally agree with her, and I believe that talking about milk sharing helps it to become less taboo. The more discussion we have surrounding milk sharing, the more babies will benefit from receiving human milk. Sharing human milk with babies who need it is extremely important, as the WHO recommends exclusive breastfeeding for babies for at least 6 months, and breastfeeding along with complimentary foods until at least two years of age. Infant formula, while it can be a viable alternative when breastmilk is not available, simply cannot begin to supply the health benefits of real human milk.

Breastmilk exists in sufficient quantities to feed the world’s babies, but not every mother has all the milk that she needs all the time. Breastmilk is, however, a commodity that doesn’t have advanced distribution channels like other commodities. But why is that? It is perhaps partly because there isn’t a profit to be made in the breastmilk industry, since selling of breastmilk is illegal in many places like Canada. It is also partly because the infant formula industry exists and many people feel that it sufficiently fills the gap.

That's why informal milksharing networks exist today. Sites like Human Milk 4 Human Babies (HM4HB) facilitate the connection between those who have more than enough, and those who are in need. As Emma Kwansica, founder of the HM4HB Global Network says about her vision for the network:

Breastmilk, the biologically normal sustenance for humankind, is a free-flowing resource and mothers of the world are willing to share it. Milksharing is a vital tradition that has been taken from us, and it is crucial that we regain trust in ourselves, our neighbors, and in our fellow women. Feeding any breastmilk substitute is not without risk and we support the families who know there is another option. We are the bridge that connects local families and brings them together again as milksharing communities. Indeed, the future of humanity depends on our return to sharing in a local and tangible way with one another.We want milksharing and wet-nursing to be commonplace and babies to be fed at women's breasts whenever and wherever they need it. We dream of a world where mothers from previous generations pass on the tradition of breastfeeding and are a wealth of knowledge and support. We can forsee a time when women protect each other and help one another feed their babies so that every mother feels whole and no mother feels broken or that her body is failing her. We imagine a world where family members, friends, lactation consultants, doctors, and midwives do not hesitate to recommend donor milk when it is needed. We envision a future where families come together to raise this generation, and the next, by nourishing human babies everywhere with human milk and unconditional love.

This is what I want, too: to be a part of normalizing human milk sharing, to give of myself and my resources as much as I can, and to help others to make those connections with each other, so more babies can grow with human milk.

To keep up with the latest information about the celebrations this week, follow World Milk Sharing Week on Facebook and Twitter. To get started donating your milk, find your community on the HM4HB network.

I'm so glad you shared this again, Amy. I think it's such a helpful resource for anyone considering milksharing from either side. Having donated myself, I am completely in agreement with your suggestions and wish I had read them before entering in to my first milk sharing relationship.

Amy, I commented on Rachel's blogpost but I didn't know if you'd read all the comments so I wanted to tell you too how thankful I was for your gift to him and to Rachel. In addition to all the wonderful physical and emotional things your milk did for them, it also gave me an unexpected opportunity as the grandma to bond more with Bennett as I occasionally fed him a bottle of your milk too. I'm sure you already know, but that precious milk was never taken for granted, and was literally treated like liquid gold. Thank you for giving of yourself in that way.

Amy. I don't even know you, but I know your lovely friend Rachel and now, because of that, my 10 week old baby boy is going to be the recipient of some of your milk that she had stored away in her freezer. I can't even express to you how relieved and thankful I am for YOU.

I had supply issues with my first son, too. And THIS time, throughout my whole pregnancy, I kept thinking, "This time, I'll get it right! I'm going to nurse so well, and so much, that I'll have milk to spare! And maybe I can even pump some extra out and give it to someone who needs it!" But, sadly, no. Once again, I have an extremely low supply, and no matter what I have tried (which is pretty much everything), I only get about 8 or 10 ounces per day. So, now I am on the other end of where I had hoped to be. And I've been heartbroken about it. Heartbroken. But now, because of you, a total stranger, I have hope again. This is SO important to me, and I have been sick every single time I have mixed up a bottle of formula (corn syrup!) for my sweet baby to eat. Just sick about it.

So, thank you. Thank you a million times. :) I feel like I just won the lottery, getting some of your milk to help feed my child. And thank you for sharing the links to the milk-sharing sites. I had no idea there was anything like that out there. I thought you had to go to a milk bank and pay $3 an oz - something we could NEVER afford. I am going to be exploring all of those, and getting this thing going ASAP. Man, I am so thankful for you!

@Mars: You are so very welcome. <3 I can't tell you how glad I am that my milk can help you out right now! And I'm so sorry that you've struggled so much with your milk supply; that's exceedingly unfair.

I've posted about your milk need on my Facebook pages and on Twitter, and Rachel posted on HM4HB, so I'm hoping through one of these avenues we can get you hooked up with some more donor milk!

@Rena: I saw both of your comments and all I can say is thank you. I am so humbled by the appreciation I've felt from your whole family, I just don't even know what to say. Just...thank you so much! I feel extremely loved.